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Anesth Analg 2006;102:25-31
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000189054.17725.73

CARDIOVASCULAR ANESTHESIA

SymmetryTM Aortic Connector Devices and Acute Renal Injury: A Comparison of Renal Dysfunction After Three Different Aortocoronary Bypass Surgery Techniques

Stephanie S. F. Fischer, FCA (SA), Barbara Phillips-Bute, PhD, Madhav Swaminathan, MD, Carmelo Milano, MD, and Mark Stafford-Smith, MD, FRCPC

Cardiothoracic Division, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to Mark Stafford-Smith, MD, CM, FRCPC, Department of Anesthesiology, Duke University Medical Center, Box 3094 DUMC, Durham, NC 27710. Address e-mail to staff002{at}mc.duke.edu.

Although the pathogenesis of acute renal injury after cardiac surgery is multifactorial, atherosclerosis of the ascending aorta and embolic burden are strong independent predictors. Use of the SymmetryTM aortic connector device (ACD) for proximal anastomosis of coronary grafts may reduce ascending aortic atheroembolism. Therefore, we tested the hypothesis that off-pump coronary artery bypass (OPCAB) surgery performed using an ACD is associated with less postoperative renal dysfunction compared with conventional OPCAB or on-pump coronary artery bypass graft (CABG) surgery. Three-thousand-three-hundred consecutive patients undergoing non-emergent aortocoronary bypass surgery were retrospectively divided into three groups by surgical procedure; Group A: OPCAB with ACD (n = 124), Group B: standard OPCAB (n = 313), Group C: on-pump CABG (n = 2863). Postoperative peak fractional change in creatinine compared with baseline was used as a measure of renal outcome. Multivariable analysis did not identify ACD use as an independent predictor of postoperative peak fractional change in creatinine (P = 0.71), although the relationships of several known renal risk factors with postoperative peak fractional change in creatinine were confirmed. We could not find evidence that OPCAB surgery using ACDs reduces acute renal injury compared with standard OPCAB or CABG surgery.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.